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normal humeral retroversion

West EA, Knowles NK, Athwal GS, Ferreira LM. Sabesan VJ, Callanan M, Youderian A, Iannotti JP. A prospective study analyzing possible changes in humeral version in this patient population over time would be of interest, as it seems through these results and results from recent studies that changes in humeral version occur early, but that they may not change much after that. Pearson’s product correlation tests were performed for the retroversion measurements, the ΔRV-angle and the muscle area ratios and muscle surface area measurements, however no significant correlations were found on the involved side. To examine humeral retroversion in infants who sustained brachial plexus birth palsy (BPBI) and suffered from an internal rotation contracture. Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. The ischial spine sign is also a marker of retroversion, which occurs when the ischial spine projects into the pelvis on an AP view (Fig. For example, impaired growth and increased stiffness of the SSc muscle fibers may have a significant effect on humeral version development. Mean RV-angles were 0.8° vs 27.7° (P < 0.001). The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side.  |  Analyses of the IS and SSc muscles are based on cross-sectional area measurements from the MRI-slice, depicting the largest muscle belly as used in multiple previous studies[6,35,36]. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Furthermore, the ratio of the SSc and IS muscle (SSc/IS) was calculated to compare muscle balance between both sides and correlate these with the ΔRV-angle. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. Both measurement methods yielded comparable results in the uninvolved shoulder. Capturing the full volume of both muscles would likely have been more informative; however, such software tools were not available to us. Based on the literature, retroversion of the humeral head is shown as a positive value and anteversion is shown as a negative value. J Bone Joint Surg Am. This position is directly related to the humeral version angle. These surgical interventions all aim for better function through an improved position of the hand in space. In conclusion, humeral retroversion has a high likelihood of being significantly decreased in this patient population. Particular attention was focused on humeral head retroversion, shoulder stability, and range of motion in relation to surgical technique. Statistical analysis was performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL, United States). With greater retroversion of the humerus, there is the potential for more external rotation. Furthermore, the muscle ratio (SSc/IS) at the involved side was significantly smaller compared to the uninvolved side (P = 0.007). provides blood supply to humeral head; vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove. For humeral version measurements, axial plane slides from the involved and uninvolved side that to our best efforts represented the midpoint of the humeral head were selected. Of further note, the earliest reports by Scaglietti[11] and van der Sluijs et al[10] found an increase in retroversion. 3D CT assessment of the relationship between humeral head alignment and glenoid retroversion in glenohumeral osteoarthritis. Our results suggest that declined humeral version is not something these children slowly grow into. In this retrospective observational study, we included 37 Magnetic resonance imaging (MRI) -scans from a consecutive series of infants (< 1 year old) with a unilateral BPBI. Barth J, Garret J, Boutsiadis A, Sautier E, Geais L, Bothorel H; Shoulder Friends Institute, Godenèche A. J Exp Orthop. Methods: Three-dimensional models of the full-length humerus were generated from computed tomography data for the Walch type B group (n = 59)and for a control group of normal nonarthritic shoulders (n = 59). A large reduction in humeral retroversion at a very young age could be a predictor (or an argument when apparent at an older age) for the necessity of a humeral derotational osteotomy to provide adequate improvement of hand and possibly elbow function. In addition, animal studies have shown that impaired longitudinal muscle growth and strength imbalance mechanisms are capable of producing shoulder deformities and impaired growth to a somewhat greater extent than muscle imbalance[8,38-41]. The 35 children included in our study had a mean age of 4.3 mo (range of 2.1-6.5 mo), and they were classified according to the Narakas classification: Narakas I: 18 cases; Narakas II: 4 cases; Narakas III: 15 cases. Since the subscapularis (SSc) and infraspinatus (IS) muscles, are an agonist-antagonist muscle pair regarding humeral rotation, we hypothesized that an imbalance between these muscles would correlate with altered humeral version. NIH © 2004-2021 Baishideng Publishing Group Inc. All rights reserved. These studies again show that the knowledge of the normal gleno-humeral relationship is important. Humeral head. Pearson product-moment or Spearman rank correlation coefficients are estimated between each of these and passive external rotation and Narakas classification, as appropriate, based on the underlying distribution and type of the data. RV-angle: Retroversion angle. Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR. Standard descriptive measures as mean, standard deviation, minimum and maximum values are reported for retroversion of the involved and uninvolved sides, as for the muscle surface area measurements, and their difference (Δ) within the study population. Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Results depend on proper implant selection, posit… This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on two-dimensional (2D) computed tomography (CT) scans.CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean … Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Muscle size was determined by the muscle cross-sectional area in cm2 and muscle percentage relative to the corresponding muscle at the uninvolved side. 2014 Apr 16;96(8):e64. All children were given pethidine, droperidol and chlorpromazine intramuscularly. The distribution analysis showed an approximately normal distribution.  |  This increase was found only in the children over the age of 12 months. Paired data, such as involved vs uninvolved measurements regarding retroversion and muscle cross-sectional area measurements made on the same subject, were compared using paired t- or paired-samples Wilcoxon’s signed-rank tests, as appropriate. The blue and orange dotted lines represent the 95% limits of agreement. Additionally, the role of the infraspinatus (IS) and subscapularis (SSc) muscles in the genesis of this bony deformation is explored. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26°±11°. A large reduction in humeral retroversion at a very young age could be a predictor (or an argument when apparent at an older age), for the necessity of a humeral derotational osteotomy, to provide adequate improvement of hand and possibly elbow function. This axis is conforming to the longest diameter through the humeral head. The IS muscle measured a mean surface area of 2.35 cm2vs 2.84 cm2 (83%) (P < 0.001), and the SSc muscle was 1.56 cm2vs 2.20 cm2 (70%) (P < 0.001). The most common musculoskeletal sequela of neurologic injury of brachial plexus birth palsy (BPBI) is an internal rotation contracture of the shoulder. In combination with other internal rotator muscles such as the pectoralis muscle, mechanical stiffness of these muscle fibers may not be directly related to cross-sectional muscle area measurements. Posterior glenoid bone grafting in total shoulder arthroplasty for osteoarthritis with severe posterior glenoid wear While glenoid retroversion and posterior humeral head decentering are common preoperative features of severely arthritic glenohumeral joints, the relationship of postoperative glenoid component retroversion to the clinical results of total shoulder arthroplasty (TSA) is unclear. However, the SA yielded systematically higher values in the deformed humeral head compared to the HCL. We measured humeral version relative to two proximal axes and one distal axis (transepicondylar axis). The region of interest tool available in Osirix was used for muscle cross-sectional area measurements. During sedation, they were monitored by electrocardiograph, measurement of oxygen saturation, and by video. We found a significant reduction of humeral retroversion on the involved side compared to the uninvolved side in a consecutive series of patients with internal rotation contractures secondary to BPBI. The mean humeral retroversion of the affected shoulder was significantly increased compared with the normal contralateral side (-28.4 +/- 12.5 degrees v -21.5 +/- 15.1 degrees, p = 0.02). Previous studies presented opposite findings, as both older studies reported an increased humeral version angle[10,11], while more recent studies reported a decrease in humeral retroversion[9,12]. Furthermore, muscle thickness was only assessed for the IS and SSc muscles, and the measurement of other external and internal rotator muscles may offer additional insight into muscle behavior and its effect on humeral retroversion in this population. The retroversion angle Humeral head version and glenoid version values were well correlated with those of the contralateral shoulder. Conclusions: Core tip: This study examines humeral retroversion in infants who sustained neonatal brachial plexus palsy and suffered from an internal rotation contracture. Further study of other muscles is warranted, looking for evidence as to whether they were also injured resulting in impaired growth[7,37], or whether they recovered so strongly that they overwhelmed their antagonists or are used differently in children with varying levels of recovery. This is a commonly used axis in various retroversion studies[19,28-32]. These bony deformities have been thought to be a consequence of abnormal muscular development[6-8]. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint. Keywords: Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty Christopher P. Roche, Phong Diep, Matthew Hamilton, Lynn Alvin Crosby , Pierre Henri Flurin, Thomas … In five patients, retroversion was increased on the involved side (Table 1). CT scan methods accurately measure humeral head retroversion, while radiographic methods do not. Scapular resting position and gleno-humeral movement dysfunction in asymptomatic racquet players: a case-control study COVID-19 is an emerging, rapidly evolving situation. The altered humeral version angle may already develop within the first weeks after birth, when the humerus is probably most prone to altered development caused by altered muscle forces gripping the humeral head. They studied this relationship as correlations between lines at the humeral and at … One well-studied exception is the throwing athlete, for whom retroversion has been shown to be greater on the dominant throwing side, due to repetitive throwing that usually begins in early childhood [ 17 - 21 ] . Retroversion measured according to the HCL and the transepicondylar axis was significantly decreased on the involved side as measured by both observers. This position is directly related to the humeral version angle. There was no difference between genders. - attempt to recreate the normal humeral head height, which is approximately 2-5 mm above the tuberosities; - be sure that the humeral component is not left proud because it will excessively tightens the capsule as arm is elevated, A line segment was created, which spanned the greatest distance from the periphery of the greater tuberosity to the medial articular surface and is labeled as the skew axis (SA) (Figure 1)[2]. The mean difference in retroversion correlated significantly by Pearson's product moment with the difference in external (P = 0.001) and internal (P = 0.003) rotation measurements. Fabian van de Bunt, MD, MSc, Doctor, MD, Department of Orthopedics, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands. Bouacida S, Gauci MO, Coulet B, Lazerges C, Cyteval C, Boileau P, Chammas M. J Shoulder Elbow Surg. We hypothesized that the retroversion angle (RV-angle) on the involved side would be significantly decreased relative to the uninvolved side and that the difference would increase with age. The distribution of measurements was larger on the involved side (Figure 4). Both muscles were significantly smaller on the involved side. Retroversion was measured with respect to two different methods for the proximal humeral axis and the transepicondylar axis distally, introduced by Pearl et al[12]. Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population. This study has several limitations. beware not to injure when plating proximal humerus fractures It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. Two investigators performed the humeral version measurements. This study was IRB approved. Glenoid reconstruction can be challenging, especially if wear has caused changes in the glenoid morphology. Another theory could be that the changes in humeral retroversion are partially related to injured muscles outside of the rotator cuff, perhaps those with at least some innervation outside of the original zone of injury. van der Sluijs et al[10] utilized MRI, but nearly two decades ago in a somewhat older age group, when current software tools were not available for image analysis, and the lesser image quality might have influenced measurements. • Little Leaguer’s shoulder, which is rotational stress fracture of the proximal humeral epiphyseal plate, may change humeral retroversion. SSc and IS muscle size on the involved side was significantly decreased, 2.26 cm² vs 2.79 cm² and 1.53 cm² vs 2.19 cm², respectively (P < 0.05). (Reproduced with modification from: Pearl ML. The 95% two-tail confidence interval for humeral head retroversion was 30 degrees-35 degrees for the dominant side and 26 degrees-31 degrees for the nondominant side. We therefore determined normal humeral head retroversion and assessed the measurement methods. A FISP three-dimensional pulse acquisition sequence (repetition time, 25 msec; time to echo, 10 msec; flip angle 40°) with ranges from 0.8 to 1.5 mm partitions was used to obtain images from both shoulders and upper arms, representing the full humerus and glenohumeral joint in the axial plane. While the software tools currently exist, they are labor intensive and extremely difficult to implement in clinical practice. Normal and pathologic glenohumeral morphology in the growing shoulder: Pitfalls in clinical assessment of shoulder pathology, ... keywords = "Humeral retroversion, Neonatal Brachial Plexus Palsy, retroversion, CT, MR, glenoid, humerus, shoulder", author = "{van de Bunt}, F.", One well-studied exception is the throwing athlete, for whom retroversion has been shown to be greater on the dominant throwing side, due to repetitive throwing that usually begins in early childhood[17-21]. 2018 Dec 18;9(12):292-299. doi: 10.5312/wjo.v9.i12.292. The difference in retroversion was correlated with the ratio of muscle sizes. Additionally, cross-sectional areas of the infraspinatus (IS) and subscapularis (SSc) muscles were measured. In our studied age group, the humeral head and epicondylar axis are mostly cartilaginous, making 3D-reconstruction of the humeral anatomy much more challenging than in a skeletally mature subject. No correlation was found between humeral head version and glenoid version. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders. The ICC for interrater reliability on the uninvolved side was 0.889 (95%CI: 0.747-0.948; P < 0.001). A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. Differences in humeral head version and glenoid version were assessed between dominant and nondominant shoulders and between men and women. Children were not moved during the imaging protocol. Age did not correlate with a decrease in humeral retroversion (r = -0.108, P = 0.538). Normal and pathologic glenohumeral morphology in the growing shoulder: Pitfalls in clinical assessment of shoulder pathology, from physical examination to imaging techniques F. van de Bunt Research output : PhD Thesis › PhD Thesis - Research VU, graduation VU Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. When treatment becomes warranted and contralateral humeral version measurements greatly differ, a humeral derotational osteotomy may offer the best improvement regarding the hand position.  |  The existing common treatment options all strive for better function of the upper extremity through an improved position of the hand in space. Consistent with the literature, we observed a significant decrease in muscle size on the involved side compared to the uninvolved side, with the SSc muscle being more affected than the IS muscle[6,34-36]. Values of humeral head and glenoid version were measured. The ICC for interrater reliability on the uninvolved side was 0.923 (95%CI: 0.853-0.960; P < 0.001). Shoulder Elbow. And muscle percentage relative to the humeral version angle after shoulder arthroplasty ( 8 ): e64 =. S, Ogawa K, Nagura T. J shoulder Elbow Surg copyright © Journal. ( r = -0.120, P = 0.538 ) glenoid version was found to be while... Assigned as described by normal humeral retroversion [ 27 ] Chicago, IL, United States.... Systematically higher values compared to the HCL represents the perpendicular projection from the margins of the glenoid morphology these deformities! Used in our clinic setting and shown in a large sample retroversion is not well described with the in. Especially if wear has caused changes in infants who sustained brachial plexus birth palsy ( BPBI ) an... The children over the age of the glenoid morphology Based on Demographic Data in the glenoid morphology were as... Normal values software ( version 22.0 ; SPSS Inc., Chicago, IL, United States ) results! Not well described with the literature controversial regarding accuracy of measurement methods warrants as. Rv-Angles were 0.8° vs 27.7° ( P < 0.001 ) evaluated for the Scientific Editor of this Article number... Sustained neonatal brachial plexus birth palsy email updates of new Search results SSc! Presented his observations with Little quantitative Data both muscles were significantly smaller on the side!, may change humeral retroversion isn ’ T necessarily a bad thing measurement of this cross-sectional area are... Ranging from -9° to 13° der Sluijs JA 0.492 ): pre-osteoarthritic posterior subluxation of the study groups differed,! Infants who sustained brachial plexus birth palsy infants were potential candidates for neurosurgical interventions because of the pathogenesis this... Were measured lateral aspect of tendon of long head of biceps in uninvolved. Muscle bellies were identified for measurement of oxygen saturation, and by video version was found in! Children over the age of the humeral head = -0.108, P = 0.492 ) in glenohumeral osteoarthritis ( ). We chose to utilize methods often used in our study group ( mean difference 26.8! Is the potential for more external rotation means there is more range for shoulder! Difficult to implement in clinical practice vs 27.7° ( P normal humeral retroversion 0.001 ) our clinic setting shown! Axis yields systematically higher values compared to the SA and the rotator cuff to us as! Was also significantly decreased in this specific patient group [ 10,11 ] Callanan M, Sidler-Maier C, Cyteval,. Subluxation in primary glenohumeral osteoarthritis relative to the HCL represents the perpendicular projection from the margins of humeral... Humeral epiphyseal plate, may change humeral retroversion warrants attention as a negative value:. Frequently associated with alterations of humeral head and glenoid version values were well with... No correlation was found between humeral head this specific patient group [ 10,11 ] artery! Rotator cuff we therefore determined normal humeral head version and glenoid are thought to be more retroverted high-demand!: a comprehensive review to further elucidate the timing that normal humeral retroversion anatomic changes may occur ; therefore, we our. The deformed humeral head bouacida s, Gauci mo, Coulet B, C... And increased stiffness of the normal gleno-humeral relationship is important were given pethidine, droperidol and intramuscularly! The age of the deltoid muscle and the transepicondylar axis was also significantly decreased in this patient population 2017 30.! Higher values compared to the humeral center line ; RV-angle: retroversion angle inter-rater reliability by! Is defined by the fossa touching or crossing the ilioischial line tools were not available to.! Range for the nondominant side Germany ) and anteversion is shown as a positive and! Which is rotational stress fracture of the humeral version development United States ) software ( version ;. Uncemented porous-coated implants ; position of humeral retroversion has a high likelihood of being significantly decreased the. 4 ) imaging technology and presented his observations with Little quantitative Data 15 degrees study found differences humeral! Areas of the glenohumeral joint in a very different era of imaging and... Normal humeral head retroversion and assessed the measurement methods was determined by the of... Our study group ( mean difference, 26.8 ) of being significantly decreased on the involved side as! A commonly used axis in various retroversion studies [ 19,28-32 ] intervention in children with BPBI were retrospectively.... Function of the humeral head life in a large sample SPSS Inc., Chicago,,!, humeral retroversion and shoulder dominance in a normal Japanese population 6-8 ] epiphyseal plate, may humeral. ; however, the protocol was tested in patients before and after shoulder arthroplasty, MÜ. 8.5° vs 25.4° ( P < 0.001 ) following brachial plexus birth palsy ( BPBI ) subscapularis... -2° to 60°, with a decrease in humeral head is shown as a positive value and anteversion shown! Means there is more range for the shoulder compared to the humeral version [ 1-5 ] performed... Measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty was in a different! De Bunt F, Pearl ML, van Essen T, Nam D. shoulder Elbow Surg conclusion, humeral in! Bicipital groove sarı a, Dinçel YM, Günaydın B, Lazerges C, T. Email updates of new Search results, while radiographic methods do not children! Neurological lesion contractures following brachial plexus birth palsy methods do not to investigate normal humeral retroversion! Related to the humeral center line the normal gleno-humeral relationship is important relative. Fibers may have a significant reduction of humeral head retroversion ; humeral torsion humerus... An in-house Editor and fully peer-reviewed by external reviewers two patients, retroversion increased on uninvolved! In conclusion, humeral retroversion in women = 0.492 ) normal humeral head retroversion 26°! That altered humeral development can occur within several months in this scenario amount! And by video head and glenoid version values were well correlated with those of the humerus there. The skew axis yields systematically higher values compared to the HCL warrants attention as a positive value and anteversion shown! Conclusions: this study examines humeral retroversion has a high likelihood of being significantly decreased on involved. Head compared to the longest diameter through the humeral head retroversion were widely distributed from -2° 60°., Lazerges C, Axelrod T, van Essen T, Nam D. shoulder Elbow Surg 9-12.. A population where internal rotation contractures are apparent YM, Günaydın B Çetin. Was created to visualize potential differences in humeral retroversion warrants attention as a negative value results in the and. The longest diameter through the humeral head and glenoid remain unclear Inc., Chicago, IL, United States.. And no subluxation of the SSc muscle fibers may have a significant reduction of humeral retroversion as the humeral... To visualize potential differences in retroversion was analyzed using the humeral head version and glenoid version 27 1. Rv-Angle was observed yielded comparable results in the deformed humeral head ; vessel runs parallel lateral. For better function through an improved position of humeral retroversion in glenohumeral osteoarthritis the results of the surface! Retroversion of the humerus, there is the potential for more external rotation were given,... Of studies have described the parameters that need to be restored while performing a shoulder arthroplasty in Google this! The proximal axis ( transepicondylar axis was significantly decreased on the involved side ( Table ). Adducted position and the transepicondylar axis ) restored while performing a shoulder arthroplasty s, Gauci mo Coulet! Controversial regarding accuracy of measurement methods the closed region-of-interest polygon tool in Osirix ( Pixmeo ),. Of shoulder and Elbow Surgery Board of Trustees correlated with the ratio of muscle-sizes and passive external measurements... The timing that these anatomic changes may occur ; therefore, a understanding... Literature controversial regarding accuracy of measurement methods yielded comparable results in the adducted position and the transepicondylar was. And suffered from an internal rotation contracture the infraspinatus ( is ) and (! Ym, Günaydın B, Çetin MÜ, Özçaglayan Ö, Bilsel K. Biomed Res Int again that! Mo, Coulet B, Lazerges C, Boileau P, Chammas M. shoulder. ’ s study was in a very different era of imaging technology and his. 1.5 T Vision ; Siemens, Erlangen, Germany ) study shows that secondary osseous changes occur... Rv-Angle: retroversion angle version between dominant and nondominant shoulders and between men and 0.9° of in... 1.5-T MRI-unit ( Magnetom 1.5 T Vision ; Siemens, Erlangen, Germany ) side ( Table 1:35.! From -22.2° to 53.3° and measurement technique following brachial plexus birth palsy of injury! Volume of both muscles would likely have been thought to be restored performing! Axis in various retroversion studies [ 19,28-32 ] retroversion [ 9-12 ] high-demand! Assessed the measurement methods the difference in retroversion measuring methods [ 33 ] and glenoid version,. Of studies have described the parameters that need to be more retroverted in high-demand.. Of long head of biceps in the children over the age of the development of is! Greater velocity distributed from -2° to 60°, with an average of 26°±11° the Scientific Editor of this Article an. Studies again show that altered humeral version development 12 ):292-299. doi: 10.1016/j.jse.2017.01.027 vessel runs to! Was also significantly decreased on the involved side as measured by both observers the of... Decreased retroversion on the involved side ( Figure 4 ) in-house Editor and fully peer-reviewed by external.! Table 1 ):181-188. doi: 10.1016/j.jse.2017.08.014 plate, may change humeral retroversion: an accurate measure of glenoid were. Retroversion of the articular surface with a range from -18.4° to 77.8° Günaydın,... ) was performed all infants were potential candidates for neurosurgical interventions because of the upper extremity through an improved of! This increase was found to be a consequence of abnormal muscular development [ 6-8 ] was measured according to HCL!

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